Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2005
Case ReportsThe use of central neuraxial techniques in parturients with factor V leiden mutation.
The factor V Leiden (FVL) mutation is a leading cause of thrombosis, particularly during pregnancy. During pregnancy, women with thrombotic disorders including FVL are often considered candidates for antepartum anticoagulation with low molecular weight heparin. ⋯ This report focuses on the anesthetic implications that arise in parturients with FVL. We recommend that anesthesiologists be made aware of FVL patients before their due date, anticoagulation with low molecular weight heparin should be transitioned to unfractionated heparin before the 38th gestational week, and multidisciplinary collaborative investigation and care should continue for this disorder.
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Nerve stimulators are widely used to assist with peripheral nerve blocks but do not eliminate the risk of nerve injury. We evaluated the histologic findings 6 h after sciatic nerve block with bupivacaine in pigs. ⋯ No signs of inflammation were observed when the muscle contraction was achieved with a current between 0.3 and 0.5 mA (P = 0.03). In conclusion, the current required to elicit a motor response, the position of the needle tip, and the subsequent likelihood of nerve damage merit further evaluation.
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Anesthesia and analgesia · Dec 2005
Airway protective reflexes evoked by laryngeal instillation of distilled water under sevoflurane general anesthesia in children.
To investigate how sevoflurane modifies airway protective reflexes in anesthetized children, we recruited patients younger than 12-yr-old for our study. Anesthesia was induced with inhaled sevoflurane in oxygen. The airway was managed with a laryngeal mask airway and the patient breathing spontaneously. ⋯ Ten subjects were included in each group. In both groups, the primary responses were passive; however, in Group 1, active reflexes were also observed in 8 of 10 subjects; no subjects in Group 2 had active reflexes (P < 0.01). We concluded that, in children, the depth of general anesthesia with sevoflurane modified airway protective reflexes.
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Anesthesia and analgesia · Dec 2005
Case ReportsPersistent cauda equina syndrome with no identifiable facilitating condition after an uneventful single spinal administration of 0.5% hyperbaric bupivacaine.
We diagnosed cauda equina syndrome 15 h after uneventful single spinal administration of 0.5% hyperbaric bupivacaine 12.5 mg through a 27-gauge pencil-point type needle. No preexisting neurologic disorder was recorded. ⋯ Resolution of most of the symptoms occurred within a few days but some foot drop persisted for 2 yr after the procedure. Bupivacaine neurotoxicity is suggested by the absence of any other identifiable cause for this neurologic deficit.
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Anesthesia and analgesia · Dec 2005
An evaluation of a vibro-tactile display prototype for physiological monitoring.
Visual displays and auditory alarms are used to convey information on physiological variables in an operating room. However, the exponential growth in the number of physiological variables and the high probability of false alarms has amplified demands on the clinician's attention. We have extended existing tactile technology to improve situational awareness and produce a practical clinical advisory device. ⋯ Most users preferred the vibro-tactile alarm although the prototype caused some discomfort. Furthermore, a combined vibro-tactile and auditory alarm had reduced accuracy when compared with the vibro-tactile alarm alone. The vibro-tactile modality shows considerable promise for clinical practice but will require further clinical testing and refinement, especially with regard to user comfort.